Diagnostic Value of Quantitative Flow Ratio on Coronary Critical Lesion and Functional Stenosis in Patients With Non-ST Segment Elevation Acute Coronary Syndrome / 中国循环杂志

Objectives:Quantitative flow ratio(QFR)is a coronary angiography-derived functional test without the need of guidewire use.Fractional flow reserve(FFR)is used as the reference standard to verify the diagnostic value of QFR in patients with non-ST-segment elevation acute coronary syndrome(NSTE-ACS)with coronary critical lesion(40%-70%stenosis)and functional stenosis. Methods:This retrospective analysis included patients with NSTE-ACS who were admitted to Fuwai Central China Cardiovascular Hospital from June 1,2018 to February 1,2023 and underwent coronary FFR examination.QFR values of target vessels were analyzed offline by AngioPlus(Shanghai Pulsation Medical Imaging Technology Co.,LTD.),the second-generation QFR detector,and anatomical parameters of the diseased vessels were recorded as follows:minimal luminal diameter(MLD),percent diameter stenosis(DS%),minimal luminal area(MLA),percent area stenosis(AS%).Functional coronary artery stenosis is defined as FFR≤0.80. Results:Using FFR as the gold standard,the AUC values of contrast-flow QFR(cQFR)and fixed-flow QFR(fQFR)for identifying functional coronary artery stenosis in NSTE-ACS patients were 0.829(95%CI:0.773-0.885,P<0.001)and 0.821(95%CI:0.766-0.875,P<0.001),respectively.The diagnostic accuracy,sensitivity and specificity of cQFR and fQFR were 81.30%,56.00%,98.63%and 76.83%,59.00%,99.04%,respectively.DeLong test showed that diagnostic performance of cQFR was significantly better than fQFR in diagnosing functional stenosis of coronary critical lesions in patients with NSTE-ACS. Conclusions:With FFR as the gold standard,QFR(especially cQFR)has certain diagnostic value in patients with NSTE-ACS with functional stenosis of coronary critical lesions.

Safety and Efficacy of Concomitant Mitral Valvuloplasty and Implantation of Domestic Third-generation Magnetically Levitated Left Ventricular Assist Device / 中国循环杂志

Objectives:To investigate the safety and efficacy of concomitant mitral valvuloplasty(MVP)and implantation of domestic third-generation magnetically levitated Corheart 6 left ventricular assist device(LVAD). Methods:Clinical data of 13 end-stage heart failure patients who underwent Corheart 6 LVAD implantation and MVP at Central China Fuwai Hospital of Zhengzhou University from October 2021 to March 2023 were retrospectively analyzed.Mortality and complication events during hospitalization and at follow-up were collected,and changes in myocardial injury biomarkers,renal function,hemodynamics,and echocardiographic indices were observed. Results:There were no perioperative deaths and no MVP-related complications in these patients.During a mean follow-up of(14.2±5.6)months,2 patients died due to COVID-19 pneumonia and cardiac arrest respectively,11 cases(84.6%)survived.There were no recurrences of moderate-to-severe mitral regurgitation in the survived patients.Compared with preoperative value,higher cardiac output,lower central venous pressure,pulmonary artery systolic pressure(PASP),and mean pulmonary artery pressure(PAMP)were evidenced at 24 h and 72 h postoperatively,estimated glomerular filtration rate was also reduced at 1 week post operation(all P<0.010).High-sensitive troponin T level was significantly increased at 1 week post operation and then reduced at 1 month post operation,but still not returned to pre-operative level([125.5±281.9]pg/ml at baseline,[1 295.6±654.6]pg/ml at 1 week post operation and[278.0±300.5]pg/ml at 1 month post operation).Echocardiography showed that compared with preoperative period,the left ventricular ejection fraction tended to be higher at 1 and 6 months postoperatively(both P>0.017),whereas left ventricular end-diastolic dimension,PASP,and PAMP were significantly reduced(all P<0.010). Conclusions:Domestic third-generation magnetically levitated Corheart 6 LVAD implantation with concomitant MVP is safe and feasible,there is no recurrence of moderate-to-severe mitral regurgitation,a significant reduction in pulmonary artery pressure,and significant hemodynamic improvement in early to mid-term postoperatively are observed in survived patients.

Construction of a clinical mortality risk prediction model for extracorporeal membrane oxygenation based on nomogram / 中华急诊医学杂志

Objective:To explore the risk factors of death in patients receiving ECMO treatment and to construct a nomogram prediction model.Methods:The clinical data of 412 consecutive patients with acute heart and (or) pulmonary failure who received ECMO treatment between April 2018 and June 2022 were retrospectively included.According to the patients' in-hospital survival, univariate correlation analysis was used to select risk factor variables, and then Lasso regression was used to screen all variables, combined with common variables, combined with clinical practice, plotted a nomogram to predict the probability of early mortality, using the area under the ROC curve (AUC), Harrell C index and calibration curve were used to evaluate and internally validate the performance of the model.Decision curve analysis was applied to assess its clinical utility.Results:Cerebral infarction, diabetes, history of cardiopulmonary resuscitation, neurological complications, acute kidney injury, lactate, hemoglobin, albumin, and platelet count were risk factors for death in patients receiving ECMO ( P<0.05).At the same time, according to the actual situation and difference variables, we constructed a nomogram with high reliability to predict the probability of death. Conclusions:The study identified the risk factors of death in patients receiving ECMO, successfully constructed and validated a nomogram prediction model, and provided a simple and reliable tool for ECMO death prediction, which is of great significance for individualized treatment of patients.

Clinical experience of changing the membranous pulmonary system during extracorporeal membrane oxygenation in infants after congenital heart disease operation / 中国小儿急救医学

Objective:To summarize the clinical experience of changing the membranous pulmonary system during extracorporeal membrane oxygenation(ECMO) in infants after congenital heart disease opration with cardiopulmonary bypass.Methods:From January to September in 2019, 6 cases of congenital heart disease with cardio-pulmonary bypass in our hospital were analyzed retrospectively, whose membrane obstruction occurred during ECMO treatment and replaced successfully.The hemodynamics and blood gas before and after replacement of ECMO system were observed, and the experience was summarized.Results:Six patients(3 males and 3 females), aging from 1 to 3 months and weighing from 3.0 to 4.9 kg, were received VA-ECMO adjuvant therapy.The ECMO system replacement process was smooth and took 175-209 s. The hemodynamic of the children was stable.The ECMO support time was 134-249 h. After the improvement of cardiac systolic function, all children were successfully withdrawn and survived.Conclusion:The improved method of liquid replacement in ECMO system can make full use of the blood components in the original system and avoid the loss of blood tangible components.According to the plan of rapid replacement, the risk of replacement will not be increased.

Comparison of the efficacy of different venous intubation in venous-arterial extracorporeal membrane oxygenation assisted lung transplantation / 中华危重病急救医学

Objective:To compare the curative effects of different venous cannulas and drainage to improve patient's whole body oxygenation during the auxiliary process of venous-arterial extracorporeal membrane oxygenation (VA-ECMO) in lung transplantation.Methods:From December 2016 to December 2019, 12 patients who were assisted by VA-ECMO in one lung transplantation in People's Hospital of Henan Province were selected as the research objects. According to the number of side holes of venous cannulas, they were divided into two groups: one group with few side holes and other group with multiple side holes. The differences in blood gas indexes among the right radial artery, left radial artery, and right internal jugular vein before and after assistance were compared, and the assistance effect was evaluated.Results:The arterial partial pressure of oxygen (PaO 2) of blood gas indexes of the right and left radial arteries in both groups were significantly higher than that before assistance [mmHg (1 mmHg = 0.133 kPa): right and left radial artery in few side holes group: 79.5±4.2 vs. 48.3±3.8 and 88.1±3.5 vs. 48.3±3.8; right and left radial artery in multiple side holes group: 67.7±5.9 vs. 48.7±3.2 and 84.0±3.8 vs. 48.7±3.2, all P < 0.05]. The arterial partial pressure of carbon dioxide (PaCO 2) of blood gas index was significantly lower than that before assistance (mmHg: 44.2±2.6 vs. 71.7±4.4 for the right radial artery and 44.7±1.4 vs. 71.7±4.4 for the left radial artery in the group with few side holes; 46.2±2.1 vs. 71.2±3.5 for the right radial artery and 44.1±1.9 vs. 71.2±3.5 for the left radial artery in the group with multiple side holes, all P < 0.05). The partial pressure of oxygen in venous blood (PvO 2) of blood gas index of ECMO system in the group with few side holes was significantly lower than that of the multiport side holes group (mmHg: 56.4±3.2 vs. 88.7±1.5, P < 0.01), and the partial pressure of carbon dioxide in venous blood (PvCO 2) was significantly higher than that of multiport side holes group (mmHg: 63.6±3.7 vs. 44.2±1.7, P < 0.01). Conclusions:When VA-ECMO is used in lung transplantation, the superior vena cava blood flow can be fully drained by using intravenous cannula with few side holes. It can effectively improve the oxygenation of the upper body of lung transplant patients, avoid the dilemma of hypoxemia in the upper body and hyperxemia in the lower body, provide more effective assistance to patients undergoing single lung transplantation, and is more meaningful for improving the oxygenation status of the whole body in patients undergoing single lung transplantation.

Single lung transplantation assisted by extracorporeal membrane oxygenation technique duringperioperative period:a report of 6 cases / 中华器官移植杂志

Objective To summarize the application experiences and curative efficacies of single lung transplantation assisted by extracorporeal circulation with coated lung ,centrifugal pump and coated pipe .Methods Retrospective analysis was conducted for clinical data of 6 adult patients with respiratory insufficiency undergoing single lung transplantation .The changes of hemodynamics and oxygenation before and after adjuvant treatment were observed ,the effects of adjuvant evaluated and the experiences of application summarized .Results The hemodynamic parameters post-assistance significantly improved as compared with that pre-assistance and pulmonary arterial pressure dropped from (56 ± 15 ) to (45 ± 13 ) mmHg with statistically significant differences . Arterial blood gas parameters significantly improved .PO2 spiked from (47 ± 12) to (68 ± 9) mmHg and PCO2 declined from (65 ± 14) to (55 ± 12)mmHg .And there were statistically significant differences .All patients were discharged successfully .Conclusions The simple extracorporeal membrane oxygenation system of coated lung , centrifugal pump and coated pipe during routine extracorporeal circulation may guarantee the operative safety of single lung transplantation and provide a new therapeutic option .

Value of patient health questionnaires (PHQ)-9 and PHQ-2 for screening depression disorders in cardiovascular outpatients / 中华心血管病杂志

<p><b>OBJECTIVE</b>To analyze the value of 2- and 9-question patient health questionnaires (PHQ-2 and PHQ-9) for screening status of depression in cardiovascular outpatients.</p><p><b>METHODS</b>From June 2013 to January 2014, a total of 201 outpatients from psycho-cardiological outpatients departments were consecutively enrolled into this study. All patients were asked to complete PHQ-9 and the mental psychological assessment by qualified researchers trained by psychiatry according to the composite international diagnostic interviews (CIDI), 50 cases were retested to assess the retest reliability after one week. The PHQ-2 and PHQ-9 were validated with the CIDI as the reference criteria.</p><p><b>RESULTS</b>According to the CIDI, 42 (21.3%) out of the 201 outpatients were diagnosed as depression. For PHQ-9 scale, a cutoff value of 10 presented satisfactory results with 87.1% sensitivity, 83.5% specificity, 58.7% positive predicting value, 95.6% negative predicting value and the area under the ROC curve (AUC) was 0.877 (SE = 0.032, 95% CI: 0.813-0.938). The Cronbach's alpha coefficients and test-retest reliability of the PHQ-9 were 0.809 and 0.882, respectively. Compared with CIDI, the cutoff value of the PHQ-2 was 3 with 85.7% sensitivity, 69.2% specificity, 57.1% positive predicting value, 93.6% negative predicting value, and the AUC was 0.806 (SE = 0.042, 95% CI: 0.774-0.889). The Cronbach's alpha coefficients and test-retest reliability of the PHQ-2 were 0.785 and 0.813, respectively.</p><p><b>CONCLUSION</b>The PHQ-2 and PHQ-9 are reliable and efficient instruments for screening and especially excluding depression in cardiovascular outpatients.</p>

Impact of metabolic risk factors and lifestyle on new onset hypertension in Beijing community residents / 中华心血管病杂志

<p><b>OBJECTIVE</b>To explore if the new onset hypertension was related with metabolic risk factors and lifestyle in Beijing community residents to guide the targeted prevention of hypertension.</p><p><b>METHODS</b>A population-based survey with a randomly cluster sampling was made to observe the relationship between metabolic risk factors and lifestyle with new onset hypertension by multivariate and logistic regression.</p><p><b>RESULTS</b>A total of 4 034 subjects with normal blood pressure at baseline were included and 978 (24.2%) residents developed hypertension two years later. Multiple logistic analysis demonstrated that risk factors that contributed to new onset hypertension were prehypertension, overweight, obesity, frequent alcohol drinking, metabolic syndrome (MS), age and male gender, the respective Odds Ratios(OR) and 95% confidence interval (95%CI) are as follows: 3.512 (2.965-4.168), 1.654 (1.423-1.918), 2.264 (1.633-2.951), 1.493 (1.231-1.775), 1.329 (1.227-1.414), 1.226 (1.115-1.335), 1.135(1.018-1.221). College education serves as the protective factor, and the OR (95%CI) was 0.692 (0.476, 0.897).</p><p><b>CONCLUSIONS</b>New onset hypertension in Beijing community residents is mainly related with prehypertension, overweight or obesity, MS, frequent alcohol drinking and low education level. We should pay more attention to modulating metabolic risk factors and lifestyle to reduce the new onset hypertension in China.</p>

Missed diagnosis of periampullary diverticulum complicated with pancreatobiliary diseases / 中华肝胆外科杂志

ObjectiveTo summarize the occurrence of missed diagnosis of periampullary diverticulum (PAD) with pancreatobiliary diseases and analyze its underlying reasons.MethodsWe conducted a retrospective analysis of 194 patients with PAD complicated with pancreatobiliary diseases from January 2006 to December 2011 in our hospital ResultsAt the first onset of pancreatobiliary diseases,the diagnosis of PAD was made in 48 patients (correct diagnosis group) and missed in 146patients (missed diagnosis group),with a rate of missed diagnosis of 75.3％.At the second,third and fourth onsets of pancreatobiliary diseases in the missed diagnosis group patients,the rates of missed diagnosis were 37.7％,21.8％,and 0％ respectively.There were no significant differences between the correct diagnosis group and the missed diagnosis group with respect to sex,age or the kinds of pancreatobiliary diseases (P＞0.05).But there were significant differences in the two groups with respect to different medical groups,period of admission,the frequency of application of CT,magnetic resonance (MRI) and magnetic resonance cholangiopancreatography (MRCP),duodenal endoscopy/endoscopic retrograde cholangiopancreatography (ERCP) and upper gastrointestinal contrast radiography (P＜0.05).The accuracy rates of CT,MRI,MRCP,upper gastrointestinal contrast radiography and duodenal endoscopy/ERCP for the diagnosis of PAD were 30.0％,31.5％,36.3％,64.5％ and 100.0％ respectively.At the first,second,third and fourth onset of pancreatobiliary diseases,the application rates of duodenal endoscopy/ERCP were 18.0％,33.6％,70.9％ and 91.7％,respectively.Compared with the missed diagnosis group,recurrence rate of symptom were lower significantly in the diagnosis group 1,2,and 3 years post-treatmnet.ConclusionsThe missed diagnosis of PAD complicated with pancreatobiliary diseases is rather common,mainly due to insufficient understanding for PAD.As a result,for PAD patients with pancreatobiliary diseases,the correct diagnosis rates of CT,MRI,MRCP and upper gastrointestinal contrast are low and the use of duodenal endoscopy/ERCP is insufficient.

EFFECT OF GLIPIZIDE ON HEPATOCYTE INSULIN RECEPTORS OF STREPTOZOTOCIN-INDUCED DIABETIC RATS / 中华内分泌代谢杂志

To determine whether glipizide has hypoglycemic effects at extrapancreatic sites, we have recently studied the effect of glipizide on hepatocyte insulin receptors of both streptozotocin (STZ)-induced diabetic rats and normal rats.Results showed that after treatment with glipizide, fasting blood glucose levels were significantly decreased in both STZ rats (P